Mechanisms for Noncontact Anterior Cruciate Ligament Injuries Knee Joint Kinematics in 10 Injury Situations From Female Team Handball and Basketball
Mechanisms for Noncontact Anterior Cruciate Ligament Injuries Knee Joint Kinematics in 10 Injury Situations From Female Team Handball and Basketball
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DOI：
10.1177/0363546510373570
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发表时间：
2010-11-01
影响因子：
4.8
通讯作者：
Krosshaug, Tron
中科院分区：
文献类型：
--
作者：
Koga, Hideyuki;Nakamae, Atsuo;Krosshaug, Tron
背景：非接触性前交叉韧带损伤的机制至今仍存在争议。对损伤录像带的视频分析是从实际前交叉韧带损伤病例中提取生物力学信息的唯一方法。目的：本文使用基于模型的图像匹配技术描述了前交叉韧带损伤情况下的三维膝关节运动学。研究设计：病例系列;证据等级，4.方法：采用基于模型的图像匹配方法对女子手球和篮球比赛中的10个前交叉韧带损伤视频序列进行分析。10例患者在初始接触（IC）时的平均膝关节屈曲角为23度（范围，11度-30度），在随后的40毫秒内增加了24度（95%置信区间[CI]，19度-29度）。IC时的平均外翻角为中性（范围，-2度至3度），但40毫秒后增加了12度（95% CI，10度-13度）。在IC时，膝关节外旋5度（范围，-5度至12度），但在前40毫秒内旋8度（95% CI，2度至14度），随后外旋17度（95% CI，13度至22度）。平均垂直地面反作用力峰值为体重的3.2倍（95%CI，2.7-3.7），发生在IC后40 ms（范围，0-83）。结论：根据关节角运动突然变化和垂直地面反作用力峰值发生的时间，前交叉韧带损伤可能发生在IC后40 ms左右。10例病例的运动学模式惊人地一致。所有运动员在IC后40毫秒内立即外翻运动。此外，胫骨在前40毫秒内旋转，然后观察到外旋，可能是在前十字韧带撕裂后。这些结果表明，外翻负荷是前交叉韧带损伤机制的一个影响因素，胫骨内旋与外翻运动相关。预防计划应侧重于获得良好的切割和着陆技术，膝关节屈曲，膝关节无外翻负荷。
Background: The mechanism for noncontact anterior cruciate ligament injury is still a matter of controversy. Video analysis of injury tapes is the only method available to extract biomechanical information from actual anterior cruciate ligament injury cases.Purpose: This article describes 3-dimensional knee joint kinematics in anterior cruciate ligament injury situations using a model-based image-matching technique.Study Design: Case series; Level of evidence, 4.Methods: Ten anterior cruciate ligament injury video sequences from women's handball and basketball were analyzed using the model-based image-matching method.Results: The mean knee flexion angle among the 10 cases was 23 degrees (range, 11 degrees-30 degrees) at initial contact (IC) and had increased by 24 degrees (95% confidence interval [CI], 19 degrees-29 degrees) within the following 40 milliseconds. The mean valgus angle was neutral (range, -2 degrees to 3 degrees) at IC, but had increased by 12 degrees (95% CI, 10 degrees-13 degrees) 40 milliseconds later. The knee was externally rotated 5 degrees (range, -5 degrees to 12 degrees) at IC, but rotated internally by 8 degrees (95% CI, 2 degrees-14 degrees) during the first 40 milliseconds, followed by external rotation of 17 degrees (95% CI, 13 degrees-22 degrees). The mean peak vertical ground-reaction force was 3.2 times body weight (95% CI, 2.7-3.7), and occurred at 40 milliseconds after IC (range, 0-83).Conclusion: Based on when the sudden changes in joint angular motion and the peak vertical ground-reaction force occurred, it is likely that the anterior cruciate ligament injury occurred approximately 40 milliseconds after IC. The kinematic patterns were surprisingly consistent among the 10 cases. All players had immediate valgus motion within 40 milliseconds after IC. Moreover, the tibia rotated internally during the first 40 milliseconds and then external rotation was observed, possibly after the anterior cruciate ligament had torn. These results suggest that valgus loading is a contributing factor in the anterior cruciate ligament injury mechanism and that internal tibial rotation is coupled with valgus motion. Prevention programs should focus on acquiring a good cutting and landing technique with knee flexion and without valgus loading of the knee.